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Prevalence of Diabetic Kidney Disease (DKD)
Fernando Carnavali, MD, comments on the prevalence of diabetic kidney disease (DKD) in the United States, the financial burden on patients and the healthcare system, as well as the importance of early detection of kidney disease in patients with diabetes.
Aida Vega, MD: Hello and welcome to Between the Lines, a journal club experience. Today's featured article is “Real-World Evidence and Clinical Utility of KidneyIntelX on Patients With Early-Stage Diabetic Kidney Disease: Interim Results on Decision Impact and Outcomes.” My name is Dr Aida Vega. I am an associate professor of medicine and director of the Mount Sinai Faculty Practice Primary Care Program at the Icahn School of Medicine at Mount Sinai in New York City. And I'm also the vice chair of Ambulatory Care for the Mount Sinai Health System. Joining me today is my colleague, Dr Fernando Carnavali, who is also an associate professor here at Mount Sinai, focusing on primary care, and he is division chief of general medicine for our Mount Sinai West campus. In today's discussion, we will be reviewing data relating to the practical and clinical implications of the risk assessment capability of the KidneyIntelX to improve screening and health outcomes in patients at risk for progressive kidney failure related to diabetic kidney disease. Type 2 diabetes is the leading cause of chronic kidney disease in the United States, impacting nearly 40% of the population. In your experience, Dr Carnavali, how many patients with chronic kidney disease or diabetic kidney disease will experience kidney function decline and progress to dialysis or transplant each year? Please comment on this.
Fernando Carnavali, MD: Thank you again for this invitation. Pleasure to be here with you, Dr Vega. And I read your article. And one of the things that we know that the number is concerning no matter how you slice it, and what we know that the people going into end stage needing dialysis or transplant, it's up to 50,000 per year. This is when we talk about CKD [chronic kidney disease] and DKD [diabetic kidney disease]. If we talk about the end-stage renal disease, the numbers are even larger and more concerning. The burden to patients is incredible. Now it's, “We need to think about our patients go into dialysis.” And we know what the impact is in their personal lives and in their family's lives.We're talking about billions of dollars, both for the people that have chronic kidney disease, and the people that are in the end stage category for kidney disease. Burden cannot be highlighted. And one of the things that we know since we're talking about diabetes, and the numbers will continue to grow in the next decade. The burden that we have for the health systems and the personal level will continue to grow. It’s a serious problem.
Aida Vega, MD: For those reasons that you've identified, clearly, we need some better ways of identifying patients before they get to the point where they haven't advanced kidney disease. Can you tell me a bit about early identification of chronic kidney disease in the diabetic population? Can you comment on the importance ofproactive assessment and detection practices for these patients?
Fernando Carnavali, MD: Yes. We are doing it. It's not that we're not doing it. The question is how effective are the current tools that we have and how uniformly we are doing it? How much are we paying attention? We know that people are not coming and saying, "Well, my kidneys are not working fine."It's a screening that needs to be taken to the next level. What we're doing, what we have been doing, is obviously not enough. We spoke about the burden to the patients and the burden to the system in the billions of dollars.Our screening needed and has seen a transformation, a before and after, on the thinking of screening. And we'll talk a bit more about that.
Aida Vega, MD: than the practice guidelines to try to screen patients for diabetic kidney disease, it's generally underdiagnosed and sometimes overlooked, unfortunately, in the primary care setting and in many other settings including the specialty settings.
Fernando Carnavali, MD: I agree with you. And we mentioned in part because of the nature of the early stages of this, which is completely asymptomatic. But independently of that, the tools that we have been using perhaps are not good enough.
Transcript edited for clarity
Man With Newly Diagnosed Type 2 Diabetes: What HbA1c Goal-And How to Get There?
May 8th 2013The patient, an active 49-year-old man, had an HbA1c of 8.6 after diabetes was first diagnosed. It’s now 7.6 with metformin and lifestyle measures. Is the current A1c goal adequate, or should you treat more aggressively?
